Provider Demographics
NPI:1679316368
Name:ELEVATE BEHAVIORAL HEATH SERVICES
Entity type:Organization
Organization Name:ELEVATE BEHAVIORAL HEATH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOLASHADE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMODU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP BC
Authorized Official - Phone:443-803-6458
Mailing Address - Street 1:33 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1515
Mailing Address - Country:US
Mailing Address - Phone:443-803-6458
Mailing Address - Fax:
Practice Address - Street 1:33 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1515
Practice Address - Country:US
Practice Address - Phone:443-803-6458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty